Frontiers in medicine · 2026
Long-term trends in the burden of leukemia subtypes in China from 1990 to 2021: a Joinpoint regression and age-period-cohort analysis based on GBD 2021.
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Shangguan Yudi, Gou Xinyue, Luo Yue, Chen Zhuo
Аннотация
BACKGROUND: Leukemia subtypes have distinct epidemiological profiles, but comprehensive comparisons of their long-term burden in China remain limited. This study assessed trends in four major leukemia subtypes from 1990 to 2021 and projected incidence rates over the subsequent 25 years.
METHODS: We used data from the Global Burden of Disease (GBD) 2021 database to analyze the burden of acute myeloid leukemia (AML), chronic myeloid leukemia (CML), acute lymphoblastic leukemia (ALL), and chronic lymphocytic leukemia (CLL) in China from 1990 to 2021, stratified by age and sex. Joinpoint regression, age-period-cohort (APC) modeling, and Bayesian APC modeling were applied to assess temporal trends, estimate age, period, and cohort effects, and project future incidence. We also summarized disability-adjusted life years (DALYs) attributable to GBD-estimated risk factors for leukemia and its subtypes.
RESULTS: In 2021, there were an estimated 105,670 new leukemia cases in China. Among the four subtypes, ALL had the highest overall burden, whereas CML had the lowest burden and showed the greatest declines in incidence, deaths, and DALYs. Joinpoint analysis revealed that the age-standardized incidence rates (ASIRs) declined for AML and CML but increased for ALL and CLL. APC analysis indicated that age was the primary determinant of incidence, with distinct age distributions and cohort patterns across subtypes. BAPC projections indicated that incidence rates would remain stable for AML and CML, gradually decline for ALL, and continue to rise for CLL through 2046. Smoking and high body-mass index were the main contributors to attributable DALYs.
CONCLUSION: Leukemia subtypes in China show distinct long-term incidence trends. The decreasing burden of AML and CML may be associated with improvements in access to diagnosis and treatment, whereas rising ALL and CLL incidence pose new public health challenges, especially among children and the elderly. Tailored, subtype- and age-specific strategies are essential for effective leukemia control and resource planning.
METHODS: We used data from the Global Burden of Disease (GBD) 2021 database to analyze the burden of acute myeloid leukemia (AML), chronic myeloid leukemia (CML), acute lymphoblastic leukemia (ALL), and chronic lymphocytic leukemia (CLL) in China from 1990 to 2021, stratified by age and sex. Joinpoint regression, age-period-cohort (APC) modeling, and Bayesian APC modeling were applied to assess temporal trends, estimate age, period, and cohort effects, and project future incidence. We also summarized disability-adjusted life years (DALYs) attributable to GBD-estimated risk factors for leukemia and its subtypes.
RESULTS: In 2021, there were an estimated 105,670 new leukemia cases in China. Among the four subtypes, ALL had the highest overall burden, whereas CML had the lowest burden and showed the greatest declines in incidence, deaths, and DALYs. Joinpoint analysis revealed that the age-standardized incidence rates (ASIRs) declined for AML and CML but increased for ALL and CLL. APC analysis indicated that age was the primary determinant of incidence, with distinct age distributions and cohort patterns across subtypes. BAPC projections indicated that incidence rates would remain stable for AML and CML, gradually decline for ALL, and continue to rise for CLL through 2046. Smoking and high body-mass index were the main contributors to attributable DALYs.
CONCLUSION: Leukemia subtypes in China show distinct long-term incidence trends. The decreasing burden of AML and CML may be associated with improvements in access to diagnosis and treatment, whereas rising ALL and CLL incidence pose new public health challenges, especially among children and the elderly. Tailored, subtype- and age-specific strategies are essential for effective leukemia control and resource planning.